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Ned's clinical summaries > Renal - pathology > Flashcards

Renal - pathology Flashcards

1
Q

what are the 3 definitions of AKI

A

increase in serum Cr by > 26.4
increase in serum Cr by 50%
reduction in urinary output

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2
Q

define stage 3 AKI

A

serum Cr >3 x the baseline
OR
px on RRT

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3
Q

define stage 1 AKI

A

serum Cr > 1.5-1.9 x baseline

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4
Q

name 3 drug classes that can cause hypo perfusion, causing pre renal AKI

A

NSAIDs (iboproufen, diclofenac, naproxen, aspirin)

ACEi - lisinopril

ARB - losartan

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5
Q

what gives rise to ATN

A

prolonged renal hypO perfusion

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6
Q

AKI Tx

A
  1. re- perfuse = 0.9%NaCl crystalloid
  2. Tx underlying cause - antibiotics if septic, stop nephrotoxins
  3. dialysis if nothing else working
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7
Q

tx for hyperkalemia

A
  1. calcium gluconate (10mls 10%)
  2. insulin, dextrose or salbutamol neb - get K+ back into cells
  3. not in acute setting - calcium resonium - prevents reabsorption from GIT
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8
Q

how do u diagnose CKD

A

need minimum 2 samples at least 90 days apart with albuminuria

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9
Q

most common cause of CKD in uk

A

diabetes (24%)

glomerulonephritis (13%)

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10
Q

most common causes of AKI

A
  1. sepsis

2. major surgery

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11
Q

what are px’s with CKD most likely to die from

A

CVD

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12
Q

what CKD stage do you start haemodialysis

A

G4 - eGFR of 15-29

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13
Q

what class is a A:CR ratio of <3

A

A1 - its good

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14
Q

what is the A:CR ratio of A3 - the worst stage

A

> 30

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15
Q

how does hypertension in CKD cause ischemic injury

A

HT causes thickened arterial walls so a narrower lumen

this means less blood gets anti the glomeruli, causing ischemic injury

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16
Q

in ischemic injury in CKD, what does the presence of the immune cells in glomeruli cause

A

the immune cells release growth factors

these growth factors cause mesangial cells to regress back into mesangioblasts

the mesangioblasts secrete extracellular matrix and this causes glomerular sclerosis

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17
Q

what is it called when excess glucose sticks to proteins

occurs in diabetes mainly in the EFFERENT arteriole

A

non-enzymatic glycation

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18
Q

what does non-enzymatic glycation in the efferent arteriole cause

A

a pressure build up in glomeruli and hyper filtration

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19
Q

what does advanced uraemia cause

A

encephalopathy and kussmaul’s breathing - metabolic acidosis

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20
Q

what is the main underlying factor in CKD MBD

A

lack of conversion of VIT D to its active form (calcitriol)

this causes hypocalcemia

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21
Q

tx for CKD MBD

A

afacacidiol - a synthetic version of activated vit D

dietary - reduce PO4, K+, salt and restrict fluid

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22
Q

who is most at risk of renal anaemia

A

diabetics

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23
Q

tx for CKD

A

BP tx - ACEi or ARB

for CVD - atorvastatin

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24
Q

how does glomerulonephritis cause reduction in GFR

A

it causes glomerular and tubular fibrosis

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25
Q

what type of cell casts are unique to glomerulonephritis

A

red cell casts!

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26
Q

nephrOtic syndrome causes proteinuria, affects podocytes and is non-proliferative. true?

A

yes - inflammatory cells do not leak out of the damaged podocytes

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27
Q

nephritic syndrome is a proliferative process and damages endothelial or mesangium cells and causes haematuria. true?

A

yes - mesnagium cell damage is more common than endothelium

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28
Q

why does hypercholesterolemia accompany nephrOtic syndrome

A

the liver is trying to create more albumin due to it being lost in urine

cholesterol is produced like a by-product

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29
Q

name 3 non-proliferative GNs

they are nephrOtic

A
  1. minimal change GN
  2. focal segmental GN
  3. membre nous GN
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30
Q

name 4 proliferative GNs

they are nephritic

A
  1. IgA neuropathy
  2. membrenoproloferative GN
  3. rapidly progressive GN
  4. post infectious GN
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31
Q

which GN shows abnormal podocytes only on electron microscopy

A

minimal change GN

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32
Q

Tx minimal change GN

A

prednisolone - most respond well

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33
Q

which is the most common GN seen on biopsy

A

focal segmental GN - has focal sclerosis

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34
Q

which GN has sub epithelial immune complex deposition, causing diffusely thickened basement membrane

A

membranous glomerulonephritis

35
Q

which GN presents within 12-72 hr of infection, usually strep pyogenes

A

IgA nephropathy

36
Q

which GN shows IgA deposits in mesangium

A

IgA nephropathy

37
Q

IgA and HSP GN tx

A
  1. ACE I/ARB to reduce proteinuria

2. corticosteroids if this doesn’t work

38
Q

how long after a URTI does post infectious GN present and how do u tx

A

usually weeks after - usually strep pyogenes is involved

tx = supportive - S/L in2-4 weeks

39
Q

what do crescents on renal biopsy suggest

A

rapidly progressive GN

40
Q

name 3 causes of RPGN

A
  1. small vessel/ANCA vasculitis
  2. SLE
  3. anti -GBM disease
41
Q

which GN shows IgA deposits in a diffuse, granular fashion on IF

A

IgA Nephropathy

42
Q

which GN is associated with HSP

A

IgA Nephropathy

43
Q

in which GN do the largest no of patients progress to ESRF in 10 years

A

focal segmental GN - 50% of them do

44
Q

which type of membrane-proliferative GN is due to genetic or acquired defect in complement pathway

A

C3 glomerulopathy

45
Q

immune complex associated membrane-proliferative GN causes deposition of immune complexes in kidney and activate complement. true?

A

yeh - usually have an underlying cause

46
Q

what is kimmerstein Wilson lesions associated with

A

diabetic glomerulosclerosis

47
Q

tx for rapidly progressive GN

A

strong immunosuppression ASAP

prednisolone
azathioprine (cytotoxic)

48
Q

which RPGN causes LINEAR IgG antibodies on IF and anti GBM antibodies?

A

Goodpastures disease -

ANCA -ive

49
Q

which RPGN causes GRANULAR antibodies on IF

A

SLE

50
Q

ANCA +ive RPGN has -ive antibodies on IF - true?

A

yeah

51
Q

what are 50% of renal adenocarcinomas linked with

A

VHL syndrome

52
Q

what benign renal tumour do 80% of tuberous sclerosis patients have

A

angiomyolipoma

53
Q

RCC may present with a right sided varicocele. true?

A

false - its a left sided one - the carcinoma can block drainage from the L spermatic vein BUT it cannot occur on the R side as the R spermatic vein drains straight into IVC

the L spermatic vein drains into the L renal vein 1st

54
Q

what are the diagnostic Ix for RCC

A
  1. US
  2. triple contrast CT - GOLD Std
  3. biopsy
55
Q

which RCC can have renal vein involvement

A

clear cell carcinoma - has a bight yellow tumour surface

associated with loss of VHL gene

56
Q

which RCC is least common and has worst prognosis

A

collecting duct carcinoma

high grade appearance and v desmoplastic stoma

57
Q

Ix for frank haematuria

A

CT urogram and cystoscopy

58
Q

what is the only situation where the cremasteric reflex is absent

A

torsion of the spermatic chord

59
Q

tx for epididymitis

A

ofloxacin (fluroquinolone)

infection most likely caused by cglamydia or gohnnorea

60
Q

which testicular cancer is most common in men <35

A

non-seminomas (45%)

61
Q

which testicualar cancer is most common in men 35-40

A

seminomas (55%)

the potato tumour

62
Q

what are the 1st lymph nodes to be affected by testicular cancer

A

para aortic lymph nodes

63
Q

in which testicular cancer is AFP raised

A

non-seminomas - esp in yolk sac ones

64
Q

which non-seminoma TC gives a positive pregnancy test (+ive beta HCG)

A

trophblastic - a wacky looking cell

65
Q

which TC has a mainly lymphatic spread

A

seminoma TC

66
Q

which TC has a mainly haemotogenous spread

A

non-seminoma

67
Q

which TC is vv responsive to radiotherapy

A

seminoma TC

68
Q

which TC is associated with placental ALP in blood

A

seminoma TC

69
Q

95% of penile cancers are what type

A

squamous CC

70
Q

what is a myeloma

A

a cancer of plasma cells

causes an overproduction og immunoglobulins

71
Q

what is the classic presentation of myeloma

A

back pain with renal failure

72
Q

what is the type of protein present in myeloma

A

Bence Jones protein

73
Q

what does CONGO RED STAINING on renal biopsy diagnose

A

amyloidosis

74
Q

difference between AL amyloidosis and AA amyloidosis

A

AL - production of abnormal Ig light chains that enter cell and cause deposits

AA - production of acute phase protein, associated with systemic inflammation

75
Q

tx for amyloidosis (isn’t curative)

A

AL - immunosuppression (steroids), chemotherapy

AA - treat underlying condition

76
Q

tx for BPH

A

1st = alpha blocker (tamsulosin)

2nd = 5a reductase inhibitor (finasteride)

surgery = TURP

77
Q

Ix prostate cancer

A

increased PSA (only look for it in symptomatic patients tho!)
trans rectal US and biopsy
MRI to stage cancer

78
Q

where is prostate cancer most likely to metastasise to

what will be its appearance

A

mets to bone

causes an osteoBLASTIC appearance - unique to prostate mets - most other mets cause an osteoLYTIC appearance

79
Q

what hormonal therapy is available in prostate cancer

A

LHRH agonists - androgen deprecation therapy

causes prostate cells to undergo apoptosis

80
Q

what type of cancer are most of the urinary bladder cancers

A

90% transitional CC

80% if the TCCs are papillary

81
Q

what is diagnostic of urinary bladder cancer

A

CT urography

82
Q

what coliform that causes UTI precipitates kidney stones

A

proteus

83
Q

Tx for pseudomonas aeuriginosa UTI

A

ciprofloxacin

84
Q

name the 3 gram +ive causes of UTI

A

enterococcus - E.Faecium is pretty resistant to antibiotics

staph saprophyticus

S.Aureus (uncommon)

Ned's clinical summaries (3 decks)

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